International Journal of Ophthalmology & Visual Science 2021; 6(3): 154-157

http://www.sciencepublishinggroup.com/j/ijovs

doi: 10.11648/j.ijovs.20210603.11

ISSN: 2637-384X (Print); ISSN: 2637-3858 (Online)

A Case History of Internal Ophthalmomyiasis, a Rare and Devastating Disease

Shams Mohammed Noman, Murtuza Nuruddin

Eye Infirmary and Training Complex, Chittagong, Bangladesh

Email address:

To cite this article: Shams Mohammed Noman, Murtuza Nuruddin. A Case History of Internal Ophthalmomyiasis, a Rare and Devastating Disease.

International Journal of Ophthalmology & Visual Science. Vol. 6, No. 3, 2021, pp. 154-157. doi: 10.11648/j.ijovs.20210603.11

Received: May 7, 2021; Accepted: June 2, 2021; Published: July 15, 2021

Abstract: To report a rare case of unilateral internal ophthalmomyiasis with complete visual loss. Method: An otherwise

healthy 12 years old boy presented with redness and painful rapid loss of vision in his right eye for the past 12 days. There was

no history of associated trauma. On examination, there was no perception of light in his right eye and normal vision in left eye.

There was severe anterior and posterior segment inflammation which prevented the view of fundus. B-scan of the right eye

showed diffuse choroidal and optic nerve thickening. Routine blood count and X-ray chest did not reveal any significant

findings. In the midst of uncertainity regarding diagnosis and to relieve the patient from severe pain, enucleation of right eye

was performed and histopathological examination of the specimen was done to confirm the diagnosis. Result: Histopathology

report showed gross irregular inflammatory thickening of the choroid with severe granulomatous inflammation. There was an

infective agent in the choroid having an outer cuticle and an irregular hyaline branching innner tube. These features were

suggestive of ophthalmomyiasis of the choroid. Conclusion: Although rare, ophthalmomyiasis should be considered in the

differential diagnosis of panuveitis. Early recognition of this condition, when tumour and other conditions are suspected, would

avoid invasive surgical procedures, such as enucleation.

Keywords: Ophthalmomyiasis, Maggot, Larvae

1. Introduction

The infestation of living vertebrate animal tissues by fly

larvae (maggots) is known as myiasis [1]. Ophthalmomyiasis

(Ophthalmic myiasis) is the infestation of the human eye, by

the maggot of certain flies from the order of diptera.

Numerous different causative agents may be found, e.g.

Cochliomyia macellaria, Oestrusbovis, Gastrophilus species,

Hypodermaspecies.

The most common reported organism in the literature is

Oestrusbovis, a boat fly highly prevalent in sheep herdening

& farming.

Cattle, sheep, deer and rodents are the host animal. By

penetration through skin, orbit or nasal cavities, human

infestation occurs. Eggs & larvae are transported to the eye

surface by vectors such as ticks, mosquito’s & also by

patient’s hands.

Less than 5% of human myiasis causes involvement of the

eye [2]. Classification of ophthalmomyiasis is based on the

portion of the eye and ocular adnexa affected. External

myiasis occurs in the lid & conjunctiva.. Larvae within the

globe is called internal myiasis. Although rare, orbital

myiasis may also take place. Because of lower mechanical

resistance of sclera to maggot’s penetration,

ophthalmomyasis interna is more frequent in children.

Maggots enter or exit the eye through the sclera, blood

stream or optic nerve [3].

The larva destroys the tissues with toxins & produces

protein. Proteolytic bacteria carried by maggots destroy these

proteins. Enzymatic digestion, in turn provides suitable

proteins for the maggot.

Myiasis of the eye lid has been reported from Cutebra

larva [4] & D. hominis causing puncture of the skin &

extrude ova beneath the surface or deposits their eggs on

open wounds resulting furuncular, boil like lesions.

2. Case Presentation

Mr. Md. Faisal Age 12 yrs. Begumgonj, Noakhali came to

CEITC with the complaints of redness and loss of vision in

155 Shams Mohammed Noman and Murtuza Nuruddin: A Case History of Internal

Ophthalmomyiasis, a Rare and Devastating Disease

R/E for 8 days. He hadno history of trauma.

On examination there was no perception of light in his

right eye and 6/6 vision in his left eye.Right eye examination

also revealed oedematous lid., Congested conjunctiva in a

ciliary pattern, Hazy and oedematous cornea. Severe

inflammation with organised fibrin in the anterior chamber.

Pupil was irregular with posterior synechia. Lens was

cataractous Posterior segment was not visible. No

abnormality was detected in his left eye.

Figure 1. B scan of the affected eye.

B-scan showed diffuse choroidal and optic nerve

thickening The provisional diagnosis was right sided

choroidal growth with pan uveitis. He was admitted and

treated conservatively. His blood picture, biochemical

analysis and urine analysis was normal. Within this time he

developed continuous severe pain in his right

eye.Enucleation of right eye was done as indication of

painful blind eye and the globe was sent for histopathological

examination.

Figure 2. Anophthalmic socket.

Rt. enucleation done and the whole globe has sent to

department of histopathology of Sheffield teaching hospitals

of United Kingdom.

Figure 3. Cross section of the specimen.

Macroscopic image of cut surface of eye. This shows gross

irregular thickening of the choroid.

Figure 4. Cross section HE stein.

Low power haematoxylin and eosin (H and E) stained

image of the eyeball. There is a central eosinophilic exudates

and inflammatory thickening of the choroids.

Figure 5. Histopathology slide.

Higher power H and E of the choroid shows a necrotic

tract (asterisk), cuffed by granulomatous inflammation

(arrow).

Figure 6. Histopathology.

H and E-The granulomatous inflammation is in turn cuffed

by a dense eosinophilic inflammatory response.

Figure 7. Histopath of choroid.

Low power H and E shows an infective agent in the

choroid (arrowed). PE=retinal pigment epithelium.

International Journal of Ophthalmology & Visual Science 2021; 6(3): 154-157 156

Figure 8. Histopath.

Higher power H and E showing an agent with an outer

cuticle and an irregular hyaline branching inner tube.

Figure 9. Magnified histopath.

Higher power H and E of theinner irregularhyaline

branching tube

Figure 10. Magnified Histopath.

The lining cells of the inner tubeare multinucleate and

contain brown pigment.

According to histopathological evidence, the patient was

diagnosed as Ophthalmomyiasis of choroid (The exact genus

and species of the fly is not ascertainable).

3. Discussion

Ophthalmic reactions to maggots have different types. The

larva may remain in the eye without inducing significant

inflammation. After the death of maggots it may cause mild

uveitis or severe inflammation. Usually, inflammation is

painless but in our case it caused painful severe panuveitis.

Criss- cross pattern faint curvilinear grey white line secondary

to disturbed retinal pigment epithelium is pathognomec [5].

This sub retinal track is called railroad track.

Visual loss may be the result of severe inflammation and

extension of railroad tracks through the macula, retinal

detachment, haemorrhage or invasion of the optic nerve. In

our case visual loss may be due to severe panuveitis & optic

nerve involvement. Due to severe inflammation thorough

intraocular examination & photography was not possible.

Management depends upon the location of the maggot &

severity of inflammation.

A maggot within the vitreous cavity with mild or no

inflammation could be left alone.

Steroid therapy is indicated in case of mild to moderate

uveitis. [6]

Photocoagulation of subretinal maggots should be

performed promptly to prevent further decrease in vision due

to continued tunneling. [7, 8]

Parsplana vitrectomy can be performed.

Removal of larva from anterior chamber by aspiration or

with forcep.

In case of external ophthalmomyiasis, normal forcep

removal of the larvae is ideal.

Ophthalmic ointment or ethyl ether can be used to block

the larvae’s respiratory pore, thereby suffocating the

organism to facilitate manual removal. According to data

from the literature on the surgical treatment of intraocular

ophthalmomyiasis, much attention has been paid to the

diversity of clinical manifestations, ranging from mild

symptoms such as eye redness to severe uveitis and

panophtalmitis with total retinal detachment.[9] An

interesting fact is that the larvae can migrate between cavities

of the eye, from the anterior chamber and vitreous cavity in

subchorioidal space [10, 11].

4. Conclusion

Although rare, Ohthalmomyiasis may be presented with red

eye with decrease vision due to retinal involvement. Untreated

cases may cause panuveitis like syndrome. Early recognition

with a detailed external & internal ophthalmic examination is

necessary to save the eye with early appropriate treatment.

References

[1] Albert & Jakobiec. Principles and practice of ophthalmology Vol-4. 3347.

[2] MC, Lee KY, Sabates FN: Ophthalmomyiasis intrna Arch ophthalmology 98: 1588-1589; 1986.

[3] Steadly LP, Pererson CA, Ophthalmomyiasis Arch Ophthalmology 1982; 14: 137-9.

[4] Doxanas MT, Watcher JR, Ophthalmomyiasis externa: A case report Md. Med J 41: 989-991, 1992.

[5] Mason GI. Bilateral Ophthalmomyiasis interna. Am J Ophthalmol 1981; 91: 65-70.

[6] Vine AK, Schatz H. Bilateral posterior ophthalmomyiasis. Ann Ophthalmol 1981; 13: 1041-3.

157 Shams Mohammed Noman and Murtuza Nuruddin: A Case History of Internal

Ophthalmomyiasis, a Rare and Devastating Disease

[7] Jakobs SM, Adelberg DA, Lewis JM, et al. Ophthalmomyiasis interna posterior, report of a case with optic atrophy. Retina 1997; 17: 310-4.

[8] Helmut Beuttmer, MD, Ophthalmomyiasis Interna Arch ophthalmology 2002; 120: 598-1599.

[9] Nicoleyumanets. Internal posterior ophthalmomyiasis. A case report. Retinal physician 2012.

[10] Nilufar. Internal ophthalmimyiasis presenting as endophthalmitis Ophthalmic Surg Lasers Imaging. Nov-Dec 2003; 34 (6): 472-4.

[11] Chiang HH, Sandhu RK, Baynham J, Wilson DJ, A case of ophthalmomyiasis interna in the Pacific Northwest.

[12] Am J Ophthalmol Case Rep. 2017 Feb 3; 6: 11-14. doi: 10.1016/j.ajoc.2017.01.002. eCollection 2017 Jun. PMID: 29260045.